Wound Management Program

Proactively Prevent Skin Breakdowns and Effectively Manage Pressure Ulcers

A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. Wounds and related conditions can affect a resident’s ability to participate in his or her activities of daily living, such as performing self-care or pursuing leisure, therefore the outcome of wounds can include social isolation, depression and anxiety. Depending on the location and severity of the wound, a person may have difficulties in areas such as:

Limitation of mobility
Management of the wound site
Pain and discomfort
Prolonged period of immobility
Poor positioning

There is a four-fold increased risk of death in geriatric residents who develop a pressure ulcer and the risk further increases to six times when the pressure ulcer does not heal (Schaum, 2005).

Death Rate is 129% higher for residents developing pressure ulcers within the first year of admission to a long term care facility (Powell, 1989) and 55% of elderly individuals living in long term care facilities have issues with incontinence which increases the risk of developing pressure ulcers (Saicido, 2009).

pt Health Wound Management Program

pt Health introduces a Wound Management Program which is designed specifically for residents living in long term care facilities that have pressure ulcers or are at risk for developing pressure ulcers. The pt Health Wound Management Program emphasizes on a proactive approach towards preventing skin breakdowns and managing pressure ulcers. Our perspective on working in this area combines a comprehensive understanding of physical, cognitive and psychological impairments with an emphasis on supporting health through participation and engagement in daily activities. The pt Health Wound Management Program takes an interdisciplinary approach to wound management and utilizes the professional expertise of various rehabilitation professions, such as physiotherapists and occupational therapists, to maintain skin integrity, promote recovery and prevent further skin breakdown.

To screen residents for the risk of skin breakdown or further develop pressure ulcers, the pt Health rehabilitation team considers a few things, including:

Nutritional status: may be impacted by the resident’s posture and independence with feeding.
Moisture: moist, macerated skin increases the risk of skin breakdown.
Incontinence: seat covers should absorb moisture away from the resident’s skin thus help keep the skin dry.
Dressings used to treat the pressure ulcer: certain dressings may contribute to increased pressure over the wound or surrounding structures.
Pain
Variety of interventions available to treat pressure ulcers: depending on the position, stage and resident’s condition, intervention utilized may vary.
Balance: stability provides freedom of movement and improves pressure redistribution.

Postural connections:

The spine is related to the position of the head and upper extremities.
Position of the sacrum influences the spinal alignment and position of the pelvis.
Position the legs affects position of the pelvis, the spine, the head & the shoulders.

Type of deformities:

Flexible deformities are correctable.
Fixed deformities require accommodations.
If flexible correction is not tolerated then only correct to a balanced functional position and accommodate.

Position of deformities:

Posterior pelvic tilt: Kyphosis
Anterior pelvic tilt: Lordosis
Pelvic obliquity: Scoliosis
Pelvic rotation: Rib hump

Physiotherapy and Occupational Therapy Interventions

1) Consider postural alignment, distribution of weight, balance, stability, support of feet and pressure reduction, when positioning a resident in a chair or a wheelchair.

2) Change or modify activities to reduce situations with pressure, friction and shear.

Changing activities may include having a bed bath rather than a shower on a commode if the commode is causing areas of high pressure
Modify situations where pressure may be increased (e.g., when seated or lying down).

3) Choose the appropriate surface to provide pressure relief

Modification of the surface to reduce pressure and shear, you should begin where the client spends the most time or where the forces are the highest
Selected surface must provide pressure redistribution, shear reduction, and microclimate control (redistribution of pressure away from the ulcer).

4) Maximize activity and mobility to eliminate or reduce friction and shear.

Activities of daily living (ADL) retraining
Muscle strength training
Active Range of Motion and Flexibility training
Balance training
Transfer training
Nutrition management

Powell, J.S.(1989). Increasing Acuity of nursing home residents and the prevalence of pressure ulcers: A ten year comparison. Decubitus, 2(2) 56-58.

Saicido, R. (2009). Pressure Ulcers and Wound Care. Retrieved January 7, 2011, from http://emedicine.medscape.com/article/319284-overview.

Schaum, K.D. (2005). Ostomy Wound Management. Retrieved January 7, 2011, from http://www.o-wm.com/issue/43.